Sarcopenia and Inflammation with Immunotherapy

The study by Bilen et al. reported that baseline sarcopenia and increased inflammatory biomarkers might have a detrimental effect on survival outcomes in patients with cancer treated with immunotherapy [1].

There are several limitations of this study that might have impacted the reported result. First, the authors included multiple tumor types with different biological characteristics with different immunogenicity, which might have affected to outcomes. More aggressive cancers with hypoimmunogenic nature such as pancreatic cancer are associated with muscle wasting and worse results regardless of if they are treated with immunotherapy or not [2, 3]. Therefore, this is an oversimplification of complex cancer biology and anticancer immunity. Moreover, patients with cancer often receive supportive therapy, such as steroids, which may directly affect the lymphocyte count without impacting the anticancer immune response [4].

The neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) have previously been shown as oncologic prognostication markers in various studies [5]. Bilen MA et al. also showed that baseline NLR, PLR, and monocyte‐to‐lymphocyte ratio were significantly related to worse clinical outcomes in the same population [6]. However, it is essential to note that decreased blood lymphocyte count is also a well‐known nutritional laboratory marker for malnutrition and is included in several indexes as well [5]. Chronic inflammation and cancer cachexia–related sarcopenia and malnutrition indicate poor treatment outcomes. Also, another study of the same group reported that the presence of liver metastasis in the same patient population is associated with poor prognosis [7]. The presence of liver metastases previously reported to be associated with worse prognosis was not evaluated in this study. Overall, heterogeneous patient populations with different disease biology, immunologic characteristics, and anthropometric parameters and perhaps several other confounding factors might have impacted the reported result of this study. We believe that immunotherapy response evaluation should not be simplified to a highly variable parameter. Well‐designed prospective studies are needed to clarify new biomarkers to evaluate immunotherapy outcome.

Disclosures

The authors indicated no financial relationships.

References

Author notes